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  • Novak, Masuma, 1969- (författare)
  • Social inequity in health Explanation from a life course and gender perspective
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><strong>Background: </strong>A boy child born in a Gothenburg suburb has a life expectancy that is nine years shorter than that of another child just 23 km away, and among girls the difference is five years. There is no necessary biological reason to this observed difference. In fact, like life length, most diseases follow a social gradient, even in a country like Sweden where many believe there is no class inequity. This social inequity in health tells us that some of us are not achieving our potential in health or in life length compared to our more fortunate fellow citizens.</p> <p><strong>Aim: </strong>This thesis attempts to explore the patterns of health inequities and the pathways by which health inequities develop from a life course and gender perspective. In particular focuses on the importance of material, behavioural, health related and psychosocial circumstances from adolescence to adulthood in explaining social inequity in musculoskeletal disorders (MSDs), obesity, smoking, and social mobility.</p> <p><strong>Method: </strong>All four papers of this thesis were based on quantitative analyses of data from a 14-year follow-up study. The baseline survey was conducted in 1981 in Luleå, Sweden. The survey included all 16-year-old pupils born in 1965. A total of 1081 pupils (575 boys and 506 girls) were surveyed. They were followed up at ages 18, 21 and 30 years with comprehensive self-administered questionnaires. The response rate was 96.5% throughout the 14-year follow-up. In addition to the questionnaires data, school records, and interviews with nurse and teachers’ were used.</p> <p><strong>Results: </strong>There were no class or gender differences in MSDs and in obesity during adolescence, but significantly more girls than boys were smokers. Class and gender differences had emerged when they reached adulthood with more women reporting to have MSDs but more men being overweight and obese. Women continued to be smokers at a higher rate than men through to adulthood. When an intersection between class and gender was considered, a more complex picture emerged. For example, not all women had higher prevalence of MSDs or smoked more than men, rather men with high socioeconomic position (SEP) had lower prevalences of MSDs and smoking than women with high SEP; and these high SEP women had lower prevalences than men with low SEP. The worst-off group was women with low SEP. The obesity pattern was quite the contrary, where women with high SEP had a lower prevalence of obesity than women with low SEP; and these low SEP women had a lower prevalence than men with high SEP. The worst-off group was men with low SEP. Regarding social mobility, health status (other than height in women) and ethnic background were not associated with mobility either for men or women.</p> <p>The results indicated that unequal distribution of material, psychosocial, health and health related behavioural factors during adolescence, young adulthood and adulthood accounted for the observed social gradients and social mobility. However, several factors from adolescence appeared to be more important for women while recent factors were more important for men. Important adolescent factors for social inequity and downward mobility were: unfavourable <em>material circumstances</em> defined as low SEP of parent, unemployed family member, and had no own room during upbringing; unfavourable <em>psychosocial circumstances</em> defined as parental divorce, poor contact with parents, being less liked in school, and low school control; and poor <em>health related behaviour</em> defined as smoking and physical inactivity. Among these factors, being less liked in school showed consistent association with all outcome measures of this thesis. Being less liked by the teachers and students was found to be more common among adolescents whose parents had low SEP. Men and women who were less liked in school during their adolescence were more likely as adults to be smokers, obese (only women), and downwardly mobile. The dominant adult life factor that contributed to class inequity in MSDs for men and women was physical heavy working conditions, which attributed to an estimated 46.9% (women) and 49.5% (men) of the increased risk in MSDs of the lower SEP group. High alcohol consumption among men with low SEP was an additional factor that contributed to class inequities in health and social mobility.</p> <p><strong>Conclusion: </strong>Social patterning of health in this cohort was gendered and age specific depending on the outcome measures. Unfavourable school environment in early years had long lasting negative influence on later health, health behavior and SEP. The thesis supports the notion of accumulation of risk that social inequities in health occurs due to accumulation of multiple adverse circumstances among the lower SEP group throughout their life course. Schools should be used as a setting for interventions aimed at reducing socioeconomic inequities in health. The detailed policy implications for reduction of social inequities in health among men and women are discussed.</p>
  • Pohl, Petra, et al. (författare)
  • Older women and men as co-creators in design of a mobile application for fall prevention
  • 2013
  • Ingår i: Early signs of mobility limitations and fall events in old age: long-term consequences and tailored preventive interventions through interactive media.
  • Konferensbidrag (refereegranskat)abstract
    • <p>IntroductionThere is a plethora of fall prevention programs for older community-dwelling people. The evidence for exercise-based programs is strong. There is a problem however with implementation and adherence. Motivational factors and barriers have been identified to some extent. Previous studies have shown that what works best is when exercise programs are tailor made, home based, and when people have access to personal feedback on a regular basis. Mobile applications for Smartphones with exercises have these advantages, and have been available for a long time, but these are most commonly directed to young and middle-aged people. There are no applications for fall prevention developed based on senior’s own wishes. The aim was to investigate how healthy older community-dwelling women and men reason and what exercises they prefer when participating in development and design of a fall prevention program in shape of a mobile application for Smartphones.Method Participatory and appreciative action research design with focus group interviews and workshops. Qualitative data analysis.Results The preliminary results show that when older community-dwelling men and women participate in developing a fall prevention program for Smartphones, they have many ideas, thoughts and experiences that may serve as a motivational factor for following a fall prevention program regularly.ConclusionThe implementation and adherence for evidence based fall preventative exercise programs is insufficient. This study will gain knowledge to design tailor made, home based fall prevention exercise programs among community-dwelling healthy seniors.</p>
  • Pohl, Petra, et al. (författare)
  • Äldre män och kvinnor som med-aktörer i design av tränings-appar för fallprevention
  • 2013
  • Ingår i: Early signs of mobility limitations and fall events in old age: long-term consequences and tailored preventive interventions through interactive media.
  • Konferensbidrag (refereegranskat)abstract
    • <p>Bakgrund och syfte:Det finns en uppsjö av olika fallpreventiva evidensbaserade träningsprogram för äldre i ordinärt boende. Även om evidensgraden är hög för viss träning finns det svårigheter med att få äldre personer att utföra träningen. Vissa motivationsfaktorer och hindrande faktorer har redan identifierats och forskningen visar att skräddarsydda, hembaserade träningsprogram med möjlighet till regelbunden återkoppling är det som fungerar bäst. Applikationer till mobiltelefoner och surfplattor erbjuder denna möjlighet, och har funnits sedan en längre tid, men dessa vänder sig oftast till yngre och medelålders personer. Det finns ännu ingen applikation som är baserad på de äldres egna önskemål. Syftet med studien är att undersöka hur friska äldre män och kvinnor i ordinärt boende resonerar och vilka övningar de föredrar när de deltar i utveckling och design av ett fallpreventivt träningsprogram i form av en applikation till smarta telefoner och surfplattor. Metoder:18 deltagare > 70 år. Deltagande och uppskattande aktionsforskning samt fokusgruppsintervjuer och workshops. Kvalitativ innehållsanalys. Resultat:De preliminära resultaten visar att när äldre män och kvinnor i ordinärt boende deltar i utvecklingen av ett fallpreventivt träningsprogram för smarta telefoner och surfplattor har de många idéer, tankar och erfarenheter som kan fungera som motiverande faktorer i syfte att utföra regelbunden fallpreventiv träning. Konklusion:Implementeringen och följsamheten för evidensbaserade fallpreventiva träningsprogram är otillräcklig. Denna studie bidrar med kunskaper för att designa skräddarsydda, hembaserade fallpreventiva träningsprogram för friska äldre personer i ordinärt boende.</p>
  • Sand, Fredrik Wolfhagen, et al. (författare)
  • Growth-limiting role of endothelial cells in endoderm development
  • 2011
  • Ingår i: Developmental Biology. - Academic Press. - 0012-1606 .- 1095-564X. ; 352:2, s. 267-277
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Endoderm development is dependent on inductive signals from different structures in close vicinity, including the notochord, lateral plate mesoderm and endothelial cells. Recently, we demonstrated that a functional vascular system is necessary for proper pancreas development, and that sphingosine-1-phosphate (S1P) exhibits the traits of a blood vessel-derived molecule involved in early pancreas morphogenesis. To examine whether S1P(1)-signaling plays a more general role in endoderm development, S1P(1)-deficient mice were analyzed. S1P(1) ablation results in compromised growth of several foregut-derived organs, including the stomach, dorsal and ventral pancreas and liver. Within the developing pancreas the reduction in organ size was due to deficient proliferation of Pdx1(+) pancreatic progenitors, whereas endocrine cell differentiation was unaffected. Ablation of endothelial cells in vitro did not mimic the S1P(1) phenotype, instead, increased organ size and hyperbranching were observed. Consistent with a negative role for endothelial cells in endoderm organ expansion, excessive vasculature was discovered in S1P(1)-deficient embryos. Altogether, our results show that endothelial cell hyperplasia negatively influences organ development in several foregut-derived organs.</p>
  • Stenberg, Gunilla, 1968-, et al. (författare)
  • A gender perspective on physiotherapy treatment in patients with neck and back pain
  • 2010
  • Ingår i: Advances in Physiotherapy. - Informa Healthcare. - 1403-8196 .- 1651-1948. ; 12:1, s. 35-41
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Women report more pain from the musculoskeletal system, and more disability, than do men. As a consequence, women more often seek healthcare than men do, and are more often on sick leave. Research shows that female patients and male patients are treated differently by physicians and that the physician's gender also influenced the choice of treatment. The aim was to study whether the patients’ and/or the physiotherapists’ gender influences physiotherapy treatments for patients with neck and/or low back pain. During 3 days in April 2006, 73 physiotherapists in primary care and private practices collected information on 586 patients with neck and/or low back pain. The information included data on the affected pain sites and the treatment procedures used by the physiotherapist. Baseline data on the physiotherapists were collected with a questionnaire. The results showed that female and male physiotherapists mainly used the same treatment procedures, but with some differences. The female physiotherapists used significantly more acupuncture and procedures directed toward treatment of mental function. They also gave their patients a unique combination of treatment procedures to a greater extent than their male colleagues. The malte physiotherapists used significantly more training of joint mobility. Male and female patients were given the same treatment.</p>
  • Stenberg, Gunilla, 1968- (författare)
  • Genusperspektiv på rehabilitering för patienter med rygg- och nackbesvär i primärvård
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Introduction</p> <p>Gender as a social and cultural construction has an impact on physiotherapist and patient beliefs, understanding, and behaviour and could affect physiotherapy encounters. Gender studies in early rehabilitation are scarce. The aim of this thesis was to study gender during different parts of the rehabilitation process for primary health care patients with neck and back pain.</p> <p>Method</p> <p>The analyses are based on data from three different samples. One sample is composed of physiotherapists and two samples consist of patients consulting primary health care providers because of neck and back pain. All data were gathered from primary health care provided in Västerbotten County.</p> <p>Baseline data on 73 physiotherapists and 586 of their patients with neck and back pain were collected by questionnaire during three consecutive days in 2006. Patient data included affected pain site and treatment procedures used by the physiotherapist (Study I). Differences in treatment procedures used by female and male physiotherapists and differences in use for female or male patients were analysed using Chi square-test, Fisher’s exact tests, Mann-Whitney U tests and logistic regressions with cluster analysis.</p> <p>Thematised interviews with 12 patients were made before the patient’s first appointment with a physiotherapist or doctor and repeated after three months. Data were analysed according to grounded theory (Study II) and qualitative content analysis (Study III).</p> <p>A comprehensive questionnaire was answered at the first appointment when patients sought a physiotherapist in primary health care. The questionnaires included questions about pain intensity, self-rated health, function, psychological stress reactions, domestic work, work environment, self-efficacy and kinesiophobia. Response patterns were linked to the International Classification of Functioning Disability and Health (ICF) and analysed using principal component analysis (PCA) and partial least squares projections to latent structures (PLS).</p> <p>Result</p> <p>Patients were given the same treatment procedures irrespective of gender. The treatment procedures most often used were training of joint motion (48%), training of muscle functions and strength training (31%), massage (31%), physical treatment (28%), information about health/ill health (24%), and acupuncture (18%). Female and male physiotherapists used the same treatment procedures with a few exceptions. Female physiotherapists used treatment for mental functions and acupuncture more often than male physiotherapists. The women gave their patients a unique mixture of treatment procedures more frequently (43%) compared to their male colleagues (25%). Male physiotherapists used more training of joint motion.</p> <p>"To be confirmed" emerged as the core category when analysing interviews that considered expectations or experiences. Five categories were extracted: "To be taken seriously", "To get an explanation", "To be individually assessed and treated", "To be invited to participate", and "To be taken care of in a trustworthy environment". These were factors leading to confirmation. Two ideal types were identified: "confident" and "ambiguous". The "confident" did not doubt their right to health care and blamed their work for causing the pain. They related to a positive identity of strong or hard working. The "ambiguous" were afraid of being regarded as old, whining women and not being taken seriously. They were ashamed of having neck or back pain and blamed themselves; they thought they were not fit enough. The ideal types were not completely defined by gender, but more men were among the "confident" ideal type and more women were among the "ambiguous" type. Patients reacted differently to feelings of being confirmed or not, and this depended on whether they were the "confident" or "ambiguous" ideal type.</p> <p>The "confident" were satisfied and reacted with reorientation when they felt confirmed, even if they were not totally cured. When not confirmed, the "confident" reacted with anger, frustration, and feelings of shame or remained proud and blamed the health care personnel for being incompetent.</p> <p>The "ambiguous" also were satisfied and felt reoriented when they were confirmed. They then moved from being an "ambiguous" type to a more "confident" type. When the "ambiguous" were not confirmed in healthcare, they became dissatisfied and unhappy. They doubted the assessment, felt forlorn, and felt increased shame. Not being confirmed was experienced more negatively by women than by men irrespective of ideal type.</p> <p>Interesting information was found about how patients view their body in relation to pain during analysis of expectations and experiences in study II interviews. This led to Study III.</p> <p>In study III, "Fear of hurting the fragile body" emerged as an interview theme. Five categories supported or undermined beliefs about pain and physical activity: "The mechanical body", "Messages about activity", "Earlier experiences of pain and activity", "To be a good citizen", and "Support to be active". Patients thought their pain was due to tissue damage and viewed their bodies in a mechanical way. Clear messages from health care personnel about activity led to less fear of physical activity. Vague and contradictory messages led to more fear. Gender-stereotyped messages were given to patients. "The take it carefully" was such a message, and was more often to women when women were thought to be weak and in need of training. Another message was "Pain goes with heavy work". This message was more often given to men when men were thought to be strong and not in need of training. Earlier experiences of pain and activity could have been positive or negative. If positive, the experiences led to less fear of engaging in physical activity. A wish to be a good citizen, such as being a good parent, led to patients being more engaged in child care and playing more than they thought was good for their pain. Women, more than men, expressed avoidance of sick leave because they did not want to be a burden to society or to their work colleagues. Patients were anxious about how to do the "correct" exercises to avoid further injury. Practical support and a follow up to adjust the training program were important to reduce the fear of engaging in physical activity and to maintain motivation.</p> <p>One hundred and eighteen patients (84 women and 34 men) completed the questionnaire. PCA of all questions identified five significant components. The model explained 37% of the variance. The predictive power was 17%. PC1 explained 17% of the variance and the predictive power was 0.13%.</p> <p>PC1 was mainly explained by questions classified in ICF as Activity and Participation. These included questions about physical function and self-efficacy (classified as Content of Thought). Questions about support (classified as Environmental Factors) and stress reactions (classified as Body Function (Emotional Functions)) mainly explained PC2. PC3 was mainly explained by reported pain and symptoms from muscles (classified as Body Functions) and domestic work and leisure time activities (classified as Activity and Participation).</p> <p>There were differences in t-scores between women and men in PC2 (p=0.045) and PC3 (p=0.003). Variables that discriminated between women and men were questions about stress reactions and support at work in PC2, and questions about pain intensity and domestic work in PC3.</p> <p>Conclusion</p> <p>As a physiotherapist working with neck and back pain rehabilitation patients, it is important to be aware of both one’s own and the patient’s preconceptions about women and men. It is also important to be aware of the impact of gender on the professional role when choosing treatment procedures in order to ensure that choices will be based on evidence of effectiveness and not from stereotypes. Awareness of the patient’s individual needs and subsequent adaptation of treatments is also important.</p> <p>Some patients display a negative self-assessment and shame. They need more support to be able to reorient. Unless these patients are confirmed, they are at risk of prolonged disability.</p> <p>Gender stereotypes can hinder rehabilitation of neck and back pain if women are seen as weak and in need of protection and men are seen as strong and not in need of preventive muscle training.</p> <p>When assessing neck and back pain patients with questionnaires, gender has less significance than when asking questions about physical function and self-efficacy. Questions about emotions of stress reactions, support at work, and pain intensity contribute to gender differences for women. Questions on the level of domestic work contribute to gender differences for men.</p>
  • Stenberg, Gunilla, et al. (författare)
  • "Getting confirmation" gender in expectations and experiences of healthcare for neck or back patients
  • 2012
  • Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 44:2, s. 163-171
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: The aim of this study was to explore, from a gender perspective, patients' expectations prior to seeking healthcare for neck or back pain, and their subsequent experiences of the care and rehabilitation they received.</p> <p>Methods: Thematized interviews with 12 patients, 7 women and 5 men, using open-ended questions, were analysed according to grounded theory. Each patient was interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later.</p> <p>Results: Analysis resulted in 5 categories: "To be taken seriously", "Getting an explanation", "To be invited to participate", "To be assessed and treated individually", and "To be taken care of in a trustworthy environment", which were linked by a core category "Getting confirmation". Two ideal types were identified: the "Confident" type, characterized by self-confidence and pride, and the "Ambiguous" type, characterized by disparagement and shame. The categories were partly perceived in different ways from the two ideal types. The ideal types were not defined by sex; however, more men were found to be of the "Confident" type and more women of the "Ambiguous" type.</p> <p>Conclusion: Gender appears to affect expectations and experiences, in addition to how patients view and express their problems. Healthcare professionals should take this into account in consultations.</p>
  • Stenberg, Gunilla, 1968-, et al. (författare)
  • 'I am afraid to make the damage worse' : fear of engaging in physical activity among patients with neck or back pain : a gender perspective
  • 2014
  • Ingår i: Scandinavian Journal of Caring Sciences. - Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 28:1, s. 146-154
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Rationale: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefsis a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active.</p><p>Aim: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care.</p><p>Method: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective.</p><p>Result: One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'.</p><p>Conclusions: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.</p>
  • Stenberg, Gunilla, et al. (författare)
  • Patterns of reported problems in women and men with back and neck pain similarities and differences
  • 2014
  • Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 46:7, s. 668-675
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: To examine similarities and differences in problem areas reported by women and men who seek physiotherapy for back or neck pain. Methods: Principal component analysis (PCA) was used to analyse questionnaire data including demographics, pain, domestic work, stress, health status, physical disability, psychosocial and physical workload, kinesiophobia and self-efficacy. Most of the questions were recruited from a number of scales, e.g. EuroQol (EQ-5D), Neck Disability Index (NDI), Oswestry Disability Questionnaire (ODQ), Tampa Scale for Kinesiophobia, and Functional-Efficacy-Scale. Results: A total of 118 patients (84 women, 34 men) completed the questionnaire. Men and women scored similarly on physical disability, functional self-efficacy and kinesiophobia, but women scored higher on stress reactions and pain intensity. PCA showed that questions about physical disability and functional self-efficacy comprised the first component and explained most of the variance in this patient group. Questions about stress and social support at work constituted the second component. Questions about domestic workload and pain comprised the third component. Gender differences were found in the second and third components. Conclusion: In general, women and men answered questions similarly, but there were differences: more women reported stress, pain and low support at work and more men reported a lower domestic workload.</p>
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